Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Wednesday, May 11, 2011

Agglutination

Today, another large Chicago hospital joined forces with one of the largest remaining local physician groups:

Naperville-based Edward Hospital said Tuesday it has formed a joint venture with the fourth-largest doctors group in the Chicago area.

The venture, which would treat as many as 100,000 patients, initially will focus on health maintenance organization patients of both the 309-bed hospital and Downers Grove-based DuPage Medical Group, which has 320 doctors and revenue of $363 million in 2010, according to Crain's annual ranking of physicians groups.

As the health care law winds its way through the courts, its effects are already profound. Each day we see the consolidation of the health care "market" as doctors groups are swallowed whole by large hospital systems as part of the "Accountable Care" organizational construct mandated by the Affordable Care Act. Now we see the west side of the Chicago suburbs are fortified.

For patients, there's little to notice at the present time since very little immediate change to care delivery will occur. (This was the intention.) But as payment screws tighten to these newly-agglutinated partners and the newly-insured flood the system in the years ahead, there still will be a woeful lack of physicians to absorb the influx of patients. Access to care for patients with insurance will remain challenging - likely more so.

The shortage of specialists continues, too. Our newly-minted specialists from the current training pool are finding it hard to find jobs because of these consolidations. Newly-formed large groups are reluctant to add new hires as they join forces with large health care systems because of concerns they are already joining many other doctors competing for the same pool of patients already. Since their new employment contracts will likely contain productivity clauses, who in their right mind would want to hire now?

So while many are paying attention to primary care shortages, specialist shortages are likely to be even more severe going forward.

6 comments:

Now it seems to me that I can recall a time when physicians sold their practices at a voracius clip to hospitals. Wasn't all that long ago.....

Oh yeh! It was when we all feared that HMOs were taking over the landscape and that we all better group up or we would be swept away by the incoming tide of managed care.

ACOs are nothing more than HMO by a different acronym. I like HMO better so why don't we call it what it is!

Back then, as I recall, we were dangled carrots that said if we improved our quality, then we would reap the fruits of this labor. Well, we all can no doubt remember how that ended. Most of the docs that sold their practices soon found they were not needed or wanted anymore and many of the deals were unwound. IPAs went belly up by the bucket load. The payback for quality that was promised just never materialized.

On top of this, under this new organizational structure, the goverment is promising that we will have these groups that will be accountable for delivering cost effective, quality care, but Medicare recipients will not be restricted in any way as to what providers they can see!! Good luck with that fairy tale!!!!

History tends to repeat itself. Have we adequately learned from these historical lessons to get things right this time?

Keith has it down pretty well. Just this time the insurers are in collusion with the government to force/scare docs and hospitals into ACO's. Problem this time will be the patients who scream and bring down this system!

Do you mean to say that a complete loss of physician autonomy isn't good for patient care? So your physician who was previously independent is now an employee of the benevolent hospital. I thought every hospital CFO took the hippocratic oath. Hospitals not doctors have the most patient interest in mind.

Ladies and gentlemen, the fox is now officially guarding the henhouse.

Voila! Obama creates the "Health Care Technician!" An 18 month, intensive course to train unionizable health care "professionals" to treat the universally covered population! After all, it's only important to the socialists to SAY that everyone is COVERED. They don't care about how it is implemented or the quality. And the union thing– well... when you dance, you've got to pay the piper.

I hope I can offer you some measure of comfort.... I was a patient of two very fine doctors (you know both of them - one VERY well) and they were both part of a large hospital group. They were great, the staff was great, the hospital was great. Only one important point to make.... If I didn't have Medicare, I never would have been able to afford my care. So what would have happened if I had been 55 and had no insurance and turned up with the same miserable leaky valve?

And what the heck does Valarie Jarrett have to do with it? I thought the bogeyman was Dr. Berwick.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.